Date:	BILL OF LADING	Page 1 of  	
SHIP FROM
Name:	Bill of Lading Number: 	
Address:
City/State/Zip: 	B A R C O D E S P A C E
SID#: 	FOB: 
SHIP TO	CARRIER NAME:   	

Name:	Location #:

Trailer number:

Address:		Seal number(s):	
City/State/Zip: CID#:	
FOB: 	SCAC:
Pro number:	
THIRD PARTY FREIGHT CHARGES BILL TO:
Name:	B A R C O D E S P A C E
Address:
City/State/Zip:	Freight Charge Terms:

SPECIAL INSTRUCTIONS:	Prepaid  	

Collect  	

3rd  Party  	


(check box)
CUSTOMER ORDER INFORMATION
CUSTOMER ORDER NUMBER	# PKGS	WEIGHT	PALLET/SLIP
Y      or      N

Master Bill of Lading: with attached underlying Bills of Lading

ADDITIONAL SHIPPER INFO

GRAND TOTAL

CARRIER INFORMATION

NMFC #	CLASS

HANDLING UNIT 	PACKAGE	COMMODITY DESCRIPTION	LTL ONLY

QTY	TYPE	QTY	TYPE	WEIGHT 	H.M.
(X)

Commodities  requiring special or additional care or attention in handling or stowing must be so marked and packaged as to ensure safe transportation  with ordinary care.

R E C E I V I N G
S T A M P S P A C E

Where the rate is dependent on value, shippers are required to state specifically in writing the agreed or

GRAND TOTAL

declared value of the property as follows:	COD Amount:  $ 	

“The agreed or declared value of the property is specifically stated by the shipper to be not exceeding

per 	.”

Fee Terms:	Collect:   	Prepaid: 
Customer check acceptable: 

NOTE  Liability Limitation for loss or damage in this shipment may be applicable.  See 49 U.S.C. - 14706(c)(1)(A) and (B).

RECEIVED, subject to individually determined rates or contracts that have been agreed upon in writing between the carrier and shipper, if applicable, otherwise to the rates, classifications and rules that have been established by the carrier and are available to the shipper, on request, and to all applicable state and federal regulations.

The carrier shall not make delivery of this shipment without payment of freight and all other lawful charges.
 	Shipper Signature

SHIPPER SIGNATURE / DATE
This is to certify that the above named materials are properly classified, packaged, marked and labeled, and are in proper condition for transportation  according to the applicable regulations of the DOT.

Trailer Loaded: 	Freight Counted: 	CARRIER SIGNATURE / PICKUP DATE

  By Shipper
 By Driver

 By Shipper
 By Driver/pallets said to contain
 By Driver/Pieces

Carrier acknowledges  receipt of packages and required placards.  Carrier certifies emergency response information was made available and/or carrier has the DOT emergency response guidebook or equivalent documentation  in the vehicle.

SUPPLEMENT TO THE BILL OF LADING	Page  	

Bill of Lading Number:  		
CUSTOMER ORDER INFORMATION	
CUSTOMER ORDER NUMBER	# PKGS	WEIGHT	PALLET/SLIP
Y 	or     N	ADDITIONAL SHIPPER INFO	

						

						

						

						
						
PAGE SUBTOTAL				
CARRIER INFORMATION	
HANDLING UNIT	PACKAGE	

WEIGHT	

H.M.
(X)	COMMODITY DESCRIPTION	LTL ONLY	
QTY	TYPE	QTY	TYPE			Commodities  requiring special or additional care or attention in handling or stowing must
be so marked and packaged as to ensure safe transportation  with ordinary care.	NMFC #	CLASS	

									

									

									

									

									
						PAGE SUBTOTAL